Necesidades transfusionales en pacientes ingresados por fractura de fémur

ObjectiveTo determine the variables and predictive factors associated with the administration and frequency of the allogenic blood transfusion (ABT) on patients diagnosed with fracture of femur requiring surgical intervention. The secondary objective was to describe the frequency and quantity of ABT on those patients.MethodA retrospective transversal observational study was performed on patients admitted to the Sagrat Cor hospital of Barcelona with a diagnosis of fractured femur that required surgical intervention in 2016. Several demographic variables were gathered along with the clinical data and outcome of transfused and non-transfused patients, including the type of fracture.ResultsThe overall sample was 257 patients. Of the patients studied, 52.9% required blood transfusion support. Patients who required ABT had haemoglobin values on admission of 11.01 gdl while those that did not require transfusion had an average value of 12.97 g/dl.Of the patients, 42.8% were on anticoagulant and/or antiplatelet therapy before the fracture occurred.ConclusionsMore than half the patients admitted for fracture of femur received blood transfusion. The data collected showed that the hospital transfusion policy offered satisfactory results. Factors associated with the need for ABT were haemoglobin levels on admission and the type of fracture. Age and ASA risk (classification system of the American Society of Anesthesiologists) were also risk factors for ABT. This information could be useful for blood saving protocols. Finally, we think that it is important that all patients that are hospitalised with a diagnosis of fracture of femur and require surgery have a blood reserve request made, given that a high percentage of them, at any time during their stay, will be transfused.     

Minimizar el volumen de descarte para la extracción de muestras sanguíneas en los pacientes críticos: ¿es factible?

IntroductionDrawing blood samples through a central venous catheter is a customary practice in intensive care units. It is indicated to discard a volume of waste blood to avoid interference in the results.AimTo determine whether a lower discard volume for obtaining blood samples from temporary central venous catheters placed into the internal jugular, femoral or subclavian vein offers valid results.MethodA quasi-experimental prospective cross-sectional study for which 65 patients of over 18 years of age in intensive care units, who had been fitted with a triple lumen central venous catheter, were recruited over a period of 8 months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and haemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5 ml from a total extracted volume of 10.2 ml, similar to the usual waste in our ambit (10 ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient were used to measure the agreement between methods. The reference change value was established as the admissible limit of variation between the pairs of samples.ResultsA total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α = 0.05 for chlorine (?0.536; 0.012); prothrombin time (?0.092; 0.019) and prothrombin activity (0.284; 1.375). The intraclass correlation coefficient was greater than 0.9 in all the variables and the limit determined for the reference change value was not surpassed by any value.ConclusionsThe results show the reliability of the blood samples drawn with a discard volume of 1.5 ml.     

Desarrollo de una guía de atención a los familiares del paciente crítico

IntroductionWithin the context of participatory action research (PAR) at an Intensive Care Unit (ICU), 4 proposals for change were agreed by consensus to improve the attention given to families of critical patients. One proposal was the creation of a guideline for attending to family members, inspired by the participants’ desire to improve the attention given to this group of users.Objectives1) To design a guide that would meet the needs of professionals and users. 2) To reach an agreement on the minimum requirements for attention given to families of critical patients.Materials and methodsQualitative methodology, based on PAR. For each of the initiatives, a working group was created, composed mainly of professionals from the ICU coordinated by a researcher. In the case of the guide, an online community was also created as a working tool to speed up communications among the participants, reducing the number of face-to-face sessions. Participation was voluntary. To draft the guideline, a Clinical Practice Guideline for support the family was made available, which had been translated into Spanish, together with an up-to-date bibliography.ResultsTwenty four professionals were involved. We developed a guide that contained the following sections: introduction, objectives, the experiences and needs of families of patients in the ICU, strategies for action, specific procedures, and hospital resources. We designed strategies for the diffusion and implementation of the guide.ConclusionsThe guide is a useful tool that offers the professionals greater assurances and unifying criteria for action. During subsequent stages of the PAR project, an assessment will be made of the impact on professionals and users.     

La visita flexible en las unidades de cuidados intensivos: beneficios para los familiares del paciente crítico

AimTo identify, analyze and summarize the main effects that may be related to flexible visitation policies for the relatives of critically ill adults.MethodA review of the literature was conducted in the following databases: PubMed, CINAHL, PsycINFO, Cochrane Library and CUIDEN. Thematic content analysis was used to evaluate selected articles.ResultsFifteen articles were included in this review. Four main themes emerged from the thematic content analysis. Themes included the main effects of flexible visitation policies for the family of the critical patients such as: improvement of satisfaction, reduction of anxiety and stress, satisfaction regarding their own family needs, and the role of the family in the patient's care.ConclusionAccording to the existing evidence, flexible visitation policies appear to be both beneficial and decisive. It seems to be necessary to favor the participation of the family in the care of the intensive patient as well as the acquisition of a more prominent role the visitation context and in their relationship with the patient.     

Necesidades y estrategias de participación propuestas por la familia en los cuidados diarios del paciente crítico

IntroductionThe continuous and technical assistance that the critical patient requires sometimes produces a barrier with the family, generating the alteration of their needs. Family involvement is beneficial to both the family and the patient.Objective1) Knowing the feelings and needs of the patients’ relative admitted to an ICU of a third level hospital in Catalonia and 2) To study the participation strategies proposed by the relatives.MethodsPhenomenological qualitative study. The sample population selected was the patients’ relatives admitted to an UCI of a 3rd level Catalan hospital from May 2017 to February 2018. The sampling was intentional, considering different typologies to guarantee the diversity of the discourse. Semi-structured interviews were conducted, analyzed thematically. The rigor criteria of Guba and Lincoln were applied.Results15 relatives were interviewed. The participants express negative, positive and transformative feelings. Psychological assistance, having more information and collaborating in the care of your family member are some of the expressed needs. Among the strategies proposed in the absence of care participation is the increase in family hours in the ICU and the support of a nurse educator care.ConclusionsIt is necessary to reorient the personnel practice incorporating strategies that further integrate the family in the daily care of the critically ill patient. Helping the family, prioritizing their needs and guiding them in learning is basic and part of the professional care.